الفهرس 
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Abstract
Acute secondary lower limbs weakness is a clinical condition characterized by rapid onset weakness. It is a broad clinical entity which entails many diagnostic possibilities.
In our study, acute disseminated encephalomyelitis was the most common cause followed by Guillian- Barré syndrome and acute transverse myelitis.
An accurate and early diagnosis of the cause is important for management and prognosis.
In light of our study, MRI is important in rapid reaching of the diagnosis of children with acute secondary inability to walk, also it is helpful in eliminating other differential diagnosis which is essential to orchestrate a proper treatment plan and achieve a rapid full recovery.
Complete history and detailed neurologic examination in the ER department is very important as it can rapidly localize the site of the lesion, whether a peripheral nerve, spinal or brain etiology which can narrow the differential diagnosis. Emergent imaging of the brain and/ or spine according to the initial examination is essential to reach a final diagnosis, which is essential in reaching an effective treatment.
In our study, of 30 children with acute secondary inability to walk, ADEM was the most common cause in about 40% of the patients. While MRI shown to be highly sensitive in detecting the lesions. However, in our study, the lesions’ size, distribution and enhancement pattern were not indication to the severity of the disease as well as it did not predict the outcome.
GBS was the second most common cause of acute secondary weakness in about 23.3% of the patients. MRI was highly sensitive and specific as nerve root thickening and enhancement was characteristic in the patients with the disease. However, in our study, pattern of nerve root enhancement was not in correlation with the severity of the disease or outcome.
ATM was found in 16.7% cause of the patients. MRI was highly sensitive in detecting the lesions. Detecting the lesions’ site and number of segments affection at the spinal cord may be helpful in predicting the severity of symptoms and outcome.
MS in children is very important to keep in mind in dealing with cases of acute secondary weakness, and it is important to well differentiate with other possible diagnosis in MRI.
Other possible neurological diseases could also result in acute secondary weakness in pediatric population, i.e. cerebrovascular stroke, spinal cord or vertebral neoplastic lesions, which MRI is very helpful in detecting the lesions and reaching the final diagnosis.